If there’s one thing we know for sure, it’s that a career in Emergency Medicine is full of challenges. So, Te Wero, the challenge, was an apt theme for the ACEM Winter Symposium in Rotorua this week. Did our New Zealand brothers and sisters rise to the challenge? They most certainly did.

From the very first moment, as delegates were welcomed in the traditional Māori way with a pōhiri (a welcome ceremony) and the wonderful singing and dancing that followed, the themes of clinical excellence, courage and social justice were at the fore. It was a special highlight to see the men of ACEM invited to learn the Haka up on stage.

In a moving opening plenary, Dr Jan Bone (@boneynz) and Dr Dominic Fleischer shared the journey of Christchurch city after the March 15 terrorist attack. In what must be the ultimate challenge, not just for individuals or a single ED, but an entire health service, the shared narrative was one of teamwork, collegiality, courage and gratitude. Well done Christchurch ED, you have done the Emergency Medicine community proud once again.

After an incident such as this, attention to the wellbeing for health professionals could not be more relevant. It is agreed by all that the responsibility for addressing the issue of physician health is shared between the individual and the organization, including our professional body ACEM. What are some of the factors that contribute to our wellness? Dr Clare Skinner (@claski) bravely showed us the impact incivility can have on staff, by relating her personal story, and reminded us of the importance of emotional leadership.

Dr Jo Egan (@jessjomatt) shared with us how despite the challenges we all face, her team have identified what can help them Thrive at work. Self-care is a great place to start (but not finish!) and having the know-how to bring excellent outcomes can make us feel great. Making connections is essential, both with patients and each other; showing appreciation and experiencing the positive emotions associated with having fun! You can see the Waitematā team thriving here https://vimeo.com/299964747

While we at WRaP EM are delighted that conversations regarding physician health have come to the forefront, clinical medicine cannot be neglected from our meetings! Dr Cecilia Rademeyer shared her lessons learnt from the implementation of care bundles for common ED conditions. President Elect, Dr Jon Bonning (@johnubonn) flew the Choosing Wisely banner and urged us to “be a thinker” when ordering tests. While the overt costs are palpable, the hidden costs less obvious, including morbidity and mortality associated with investigating the frequently found incidentalomas. Take home message: STOP! Don’t just do something, stand there!

Surfing the Silver Tsunami attended not only to our aging community, but our aging physician selves! Workforce planning data suggests that in the near future, there will be greater numbers of Emergency Physicians in their 50s, 60s and 70s which opens an interesting conversation about how we can make Emergency Medicine careers more flexible and sustainable – keep an eye out for the WRaP EM workshop on this topic at Autumn Symposium later this month!

The panel discussion turned to the care of our vulnerable, elderly patients, especially regarding the deliriogenic nature of emergency departments. Pearls on how to avoid the development of delirium in ED included:

Introduce yourself!

Keep patients informed on what is happening and how long it will take

Treat pain

Provide food and drink

Access to natural light and clocks

In a week during which an international survey announced that the Kiwi accent is the sexiest in the world, Dr Tim Parke (@trjparke) traveled all the way from Glasgow, with his 6th ranked Scottish accent, to share his ideas not only on retrieval medicine, but regarding the humanitarian right that is access to heath care. Quoting Ghandi, he shared the message that “The true measure of any society can be found in how it treats its most vulnerable members”. He stated that at our worst moment on our worst day we should all be guaranteed excellence and equity in clinical care with dignity, compassion and aroha (love, affection) and that ED overcrowding is indeed a humanitarian crisis. He challenged the audience that every time we put on our scrubs at the start of our shift it signals our role as a social justice warrior, a role that we are proud as Emergency Physicians to uphold.

One issue that ACEM is tackling head on is that of diversity in our college, where we are batting 0 for 10 on female board members. A new section – AWE – Advancing Women in Emergency has been established to promote diversity and aim for the elimination of bias and inequality. The aims of AWE are to provide networking opportunities, mentorship, advocacy, research and leadership. Speaking of inspirational leadership, the presenters at this popularly subscribed breakfast included Dr Clare Skinner (@claski), Dr Kim Hansen (@hansendisease) and Dr Vanessa Thornton. Despite the widespread belief that the gender pay gap exists due to the number of hours worked, there remains a 16% difference in gendered wage once this has been accounted for, due in part to the seniority of roles and access to discretionary pay. Dr Skinner’s call to action was to be aware of your rights and use the Workplace Gender Equity Agency Toolkit.

Dr Sally McCarthy (@SallyMcCEP), who is published on the topic of gender inequity in Emergency Medicine spoke in a separate session and this tweet from Dr Belinda Hibble sums it up nicely.

One of the most powerful presentations came not from an Emergency Physician, but from Ms Tusha Penny, the Assistance Commissioner to NZ Police. Having grown her career tending family violence and child protection, Tusha spoke passionately about the privilege of being a leader and having the courage to stand up for those who cannot stand up for themselves. She challenged us to reflect on our “why” when it came to choosing medicine and whether when we look in the mirror, we have indeed grown into the leaders we intended to become.

A highlight of the week for ACEM and our New Zealand colleagues was the unveiling of the Manaaki Mana strategy, an initiative to improve its emergency care and improve health outcomes for Māori.

In a final, moving plenary, Dr Jan Bone (@boneynz) once again had the delegates on an emotional rollercoaster as she shared two very personal stories about much-loved colleagues – one who asked for help and survived, and one, who sadly, did not. Boney implored us to believe that bravery is not the thing you achieve on your best day, rather it is asking for help on your worst day. You, me, us.

The conference wrapped up with our ACEM Presidents past, present and future standing up to share what they saw as their biggest challenges in their role as ACEM President. Topics such as the role of the college in advocacy on a range of social justice issues, diversity, gender equity, career sustainability and calling out bad behavior in colleagues were all up for discussion. The highly anticipated announcement of the 2021 ASM being held in Christchurch ended the session on a high note along with a big thank you to the organizing committee for such as well-run and enjoyable conference.

Rotorua city itself put on gorgeous sunrises over the lake and wonderful weather for delegates for most of the week. Despite rumours that the sulphur smell would be overpowering, it was not enough to stop many delegates heading out in search of the many outdoor activities on offer, including treetop walks in the redwood forest, geothermal parks with mud pools and geysers, mountain biking, luge rides and zorbing. Rotorua was a superb choice of venue for those of us who made the trip from the Australian mainland, to experience some of the many wonders that New Zealand has to offer. I suspect that many of us are already planning our next trip back.